显微镜下多血管炎并发肺肾综合征1例报告并文献分析

Report of one case of pulmonary renal syndrome complicated with microscopic polyangiitis and literature review

目的探讨显微镜下多血管炎（MPA）并发肺肾综合征的临床特点、诊断和治疗，提高临床医师对MPA的认识和诊治水平。方法回顾性分析威海中心医院2016年3月确诊的1例MPA并发肺肾综合征患者的临床资料，并结合文献对其临床表现、诊治方法进行分析。结果该患者以咯血为首发症状就诊，同时存在急性肾衰竭，病情迅速进展。P-ANCA阳性，肾组织活检及肺泡灌洗液对其确诊意义重大。经机械通气、激素、环磷酰胺、血浆置换综合治疗临床症状缓解。结论MPA为跨学科疾病，重症患者多同时合并肺肾严重损伤，病隋危重，易误诊、漏诊，及时诊断、正确治疗是改善其预后的关键。

Objective To explore the clinical characteristics, diagnosis and treatment of pulmonary renal syndrome complicated with microscopic polyangiitis （MPA） in order to elevate realization about MPA and improve diagnositic level. Methods One diagnosed case of pulmonary renal syndrome complicated with MPA in our hospital in March 2016 was retrospectively analyzed, and the relevant literatures were reviewed. Results The patient came with hemoptysis, accompanied by involved acute kidney injury. P-ANCA was positive, characteristic histology on biopsy and bronchoalveolar lavage fluid were helpful to identify the disease. Symptomatic remission was acquired after the treatment with mechanical ventilation, glucocorticoid, cyclophosphamide, and plasma exchange. Conclusion MPA is a interdisciplinary disease, severe patients complicated with multiple simultaneous lung and kidney injury. The early diagnosis and appropriated treatment are essential to optimizing outcomes.